Laparoscopy

Overview

Laparoscopy is a surgical approach in which a doctor uses multiple, small (0.5-2 cm) incisions and a thin, lighted, tube-enclosed camera (laparoscope) to visualize and manipulate a patient’s internal organs. Such an approach, when appropriate, typically entails lower risk and quicker recovery for the patient than a surgery with a larger, single incision, called a laparotomy.

Your doctor may recommend a laparoscopy to examine potential causes or indications of pelvic pain, endometriosis or infertility. Many other procedures can be performed laparoscopically. These include removing ovarian cysts (ovarian cystectomy), removing one or both ovaries, removing the uterus (hysterectomy), removing fibroids (myomectomy), treating endometriosis, permanent sterilization, or removing an ectopic pregnancy. Some urinary incontinence procedures also can be performed laparoscopically.

A laparoscopy is done only in the operating room with general anesthesia. You will be asked not to eat or drink for eight hours prior to the procedure. During a laparoscopy, your abdomen is filled with carbon dioxide to lift the abdominal wall away from the uterus, ovaries and bowel. Additional small incisions, usually less than an inch long, are made to insert other surgical instruments. The number of total incisions varies from as few as one incision (tubal ligation) to five incisions, depending on the number of instruments that need to be used simultaneously to complete the surgery. A laparoscopy may range from 30 minutes to several hours depending on the nature of the surgery. After the procedure, the skin incisions are closed with stitches or surgical glue. As the incisions are very small, the result is much less visible than a single long incision.

Most patients go home the same day as the operation, but for more substantive procedures, such as a hysterectomy, patients may stay overnight in the hospital. Most people will be able to return to normal activities within a few days to two weeks after the operation, depending on the type of operation.

Most patients will require pain medication for a few days after the procedure to help manage soreness around the incisions. Your doctor will prescribe pain relievers, such as acetaminophen (Tylenol), ibuprofen (Motrin), or stronger pain medications such as oxycodone (a narcotic). The main advantages of laparoscopic surgeries are less blood loss, less scarring and lower risk of infection compared to operations with larger incisions.

Alternatives

Most women are good candidates for laparoscopy, but the minimally invasive approach may not be an option in every patient’s case. Factors that determine whether you are a good candidate for laparoscopy include:
  • Your history of previous surgery. Scar tissue from a previous abdominal surgery can make laparoscopy more dangerous.
  • The size of the ovarian cyst or uterus.

Effectiveness

Laparoscopy is an excellent way for physicians to view the uterus, fallopian tubes and ovaries. Depending on the indication for its use, it can help evaluate and resolve ovarian cysts, uterine fibroids or other pelvic masses. Laparoscopy also may be used during a hysterectomy.

Talk with your doctor about the effectiveness of laparoscopy and whether it is an option for you. Sometimes a surgeon may discover during surgery that laparoscopy is not possible and making a larger incision is necessary. This is often because of scarring inside a patient’s abdomen from a previous surgery. Your doctor will discuss how likely this is in your case during your pre-operative visit.

Risks

Laparoscopy is in general a safe outpatient procedure. The collective risks of laparoscopy are less than 1 percent, but include bleeding, infection, and damage to the bowel, bladder, blood vessels, nerves or hernia. Due to the complexity of some operations, your surgeon may decide mid-procedure that a larger incision is needed to complete the procedure.